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==Natural History==
==Natural History==
* In '''Legionnaires' disease''' the symptoms usually begin 2 to 14 days after being exposed to the bacteria.  They tend to get worse during the first 4 - 6 days.  They typically improve in another 4 - 5 days.
===Legionnaires' Disease===
 
*The majority of patients do not develop any symptoms (low attack rate). Patients who demonstrate clinical manifestations (approximately 5% to 10%) usually have other co-morbidities (see [[Legionellosis risk factors| ''Risk Factors'']].
* The time between the patient’s exposure to the bacterium and the onset of illness for '''Pontiac Fever''' is shorter, generally a few hours to 2 days. The symptoms usually last for 2 to 5 days. Symptoms go away on their own without treatment and without causing further problems.
* Infected individuals usually start to develop symptoms 5-7 following transmission (range: 2 days to 19 days).<ref name="pmid24970283">{{cite journal| author=Phin N, Parry-Ford F, Harrison T, Stagg HR, Zhang N, Kumar K et al.| title=Epidemiology and clinical management of Legionnaires' disease. | journal=Lancet Infect Dis | year= 2014 | volume= 14 | issue= 10 | pages= 1011-21 | pmid=24970283 | doi=10.1016/S1473-3099(14)70713-3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24970283 }} </ref>
 
*Patients report worsening of symptoms of pneumonia (fever, cough, chest pain, dyspnea) at 4 to 6 days following onset of symptoms.<ref name="pmid24970283">{{cite journal| author=Phin N, Parry-Ford F, Harrison T, Stagg HR, Zhang N, Kumar K et al.| title=Epidemiology and clinical management of Legionnaires' disease. | journal=Lancet Infect Dis | year= 2014 | volume= 14 | issue= 10 | pages= 1011-21 | pmid=24970283 | doi=10.1016/S1473-3099(14)70713-3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24970283 }} </ref>
*The majority of patients report resolution 10 days after symptom onset.
*Approximately 1% to 20% of individuals progress to develop Legionnaires'related complications and death.
===Pontiac Fever===
*Unlike Legionnaires's disease, the attack rate of Pontiac fever is high, and as many as 90% to 95% of exposed individuals will develop symptoms.<ref name="pmid24970283">{{cite journal| author=Phin N, Parry-Ford F, Harrison T, Stagg HR, Zhang N, Kumar K et al.| title=Epidemiology and clinical management of Legionnaires' disease. | journal=Lancet Infect Dis | year= 2014 | volume= 14 | issue= 10 | pages= 1011-21 | pmid=24970283 | doi=10.1016/S1473-3099(14)70713-3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24970283  }} </ref>
*Pontiac fever is characterized by milder symptoms with a shortt illness duration (typically 1-2 days).
*Symptoms of Pontiac fever typically last for a total of 2 to 5 days.<ref name="pmid24970283">{{cite journal| author=Phin N, Parry-Ford F, Harrison T, Stagg HR, Zhang N, Kumar K et al.| title=Epidemiology and clinical management of Legionnaires' disease. | journal=Lancet Infect Dis | year= 2014 | volume= 14 | issue= 10 | pages= 1011-21 | pmid=24970283 | doi=10.1016/S1473-3099(14)70713-3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24970283  }} </ref>
*Development of Pontiac fever-related complications is very rare.
==Complications==
==Complications==
Complications that can develop as a result of Legionellosis:
Complications may develop among patients who develop Legionnaires' disease. Complications may include:<ref name="pmid24970283">{{cite journal| author=Phin N, Parry-Ford F, Harrison T, Stagg HR, Zhang N, Kumar K et al.| title=Epidemiology and clinical management of Legionnaires' disease. | journal=Lancet Infect Dis | year= 2014 | volume= 14 | issue= 10 | pages= 1011-21 | pmid=24970283 | doi=10.1016/S1473-3099(14)70713-3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24970283  }} </ref>
* [[Empyema]]
* [[Empyema]]
* [[Emphysema]]
* [[Emphysema]]
* [[Lung failure]]
* [[Lung failure]]
* [[Renal failure]]
* [[Acute kidney injury]]
* [[Peripheral neuropathy]]
* [[Peripheral neuropathy]]
* [[Multiorgan failure]]
* [[Sepsis|Severe sepsis]], [[septic shock]], and [[multiorgan failure]]  


In contrast, Pontiac fever is not usually associated with any complications.
==Prognosis==
==Prognosis==
* [[Death]] occurs in 5% - 30% of Legionnaires' disease cases.
* Without treatment, Legionnaires' disease is associated with a case-fatality rate of approximately 5% to 20%.<ref name="pmid24970283">{{cite journal| author=Phin N, Parry-Ford F, Harrison T, Stagg HR, Zhang N, Kumar K et al.| title=Epidemiology and clinical management of Legionnaires' disease. | journal=Lancet Infect Dis | year= 2014 | volume= 14 | issue= 10 | pages= 1011-21 | pmid=24970283 | doi=10.1016/S1473-3099(14)70713-3 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24970283  }} </ref>
*A substantially higher proportion of fatal cases occur during [[nosocomial]] outbreaks.
* Individuals with significant co-morbidities (e.g. renal failure, advanced COPD) are at higher risk of legionellosis-related death.
* [[Pontiac fever]] is a self-limited disease that requires no treatment. Legionnaires' disease can be very serious and can cause death in up to 5% to 30% of cases. Most cases can be treated successfully with antibiotics [drugs that kill bacteria in the body], and healthy people usually recover from infection.
* A substantially higher proportion of fatal cases occur during [[nosocomial]] outbreaks.
* [[Pontiac fever]] has an excellent prognosis and is almost always a self-limited disease.  


==Sources==
* CDC Legionellosis [http://www.cdc.gov/legionella/patient_facts.htm]
==References==
==References==
{{reflist|2}}
{{reflist|2}}

Revision as of 16:54, 15 January 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The fatality rate of Legionnaires' disease has ranged from 5 to 30% during various outbreaks. It should be noted that some people can be infected with the Legionella bacterium and have only mild symptoms or no illness at all.

Natural History

Legionnaires' Disease

  • The majority of patients do not develop any symptoms (low attack rate). Patients who demonstrate clinical manifestations (approximately 5% to 10%) usually have other co-morbidities (see Risk Factors.
  • Infected individuals usually start to develop symptoms 5-7 following transmission (range: 2 days to 19 days).[1]
  • Patients report worsening of symptoms of pneumonia (fever, cough, chest pain, dyspnea) at 4 to 6 days following onset of symptoms.[1]
  • The majority of patients report resolution 10 days after symptom onset.
  • Approximately 1% to 20% of individuals progress to develop Legionnaires'related complications and death.

Pontiac Fever

  • Unlike Legionnaires's disease, the attack rate of Pontiac fever is high, and as many as 90% to 95% of exposed individuals will develop symptoms.[1]
  • Pontiac fever is characterized by milder symptoms with a shortt illness duration (typically 1-2 days).
  • Symptoms of Pontiac fever typically last for a total of 2 to 5 days.[1]
  • Development of Pontiac fever-related complications is very rare.

Complications

Complications may develop among patients who develop Legionnaires' disease. Complications may include:[1]

In contrast, Pontiac fever is not usually associated with any complications.

Prognosis

  • Without treatment, Legionnaires' disease is associated with a case-fatality rate of approximately 5% to 20%.[1]
  • Individuals with significant co-morbidities (e.g. renal failure, advanced COPD) are at higher risk of legionellosis-related death.
  • A substantially higher proportion of fatal cases occur during nosocomial outbreaks.
  • Pontiac fever has an excellent prognosis and is almost always a self-limited disease.

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Phin N, Parry-Ford F, Harrison T, Stagg HR, Zhang N, Kumar K; et al. (2014). "Epidemiology and clinical management of Legionnaires' disease". Lancet Infect Dis. 14 (10): 1011–21. doi:10.1016/S1473-3099(14)70713-3. PMID 24970283.


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